| • | persistent infection occurs in 50% to 80% of those infected and may lead to the development of chronic liver disease, cirrhosis, or hepatocellular carcinoma |
| • | single stranded RNA virus |
| • | chronic infection leads to fluctuating pattern of transaminitis (i.e. serum transaminases may be normal) |
| • | a positive anti-HCV EIA (enzyme immunoassay - detects presence of anti-HCV antibodies) followed by a confirmatory RIBA (recombinant immunoblot assay) is the most common diagnostic pathway |
autoimmune associations:
| • | the autoimmune associations reported with HCV infection justify its consideration in the ddx of rheumatic disease patients |
| • | the optimal treatment for HCV-related autoimmunity remains to be defined: |
| • | IFN-alpha seems to be most effective for symptomatic essential mixed cryoglobulinemia (with or without glomerulonephritis); however, the relapse rate on discontinuation of IFN-alpha is high |
| • | there is only anecdotal evidence that IFN-alpha improves other HCV-related autoimmune diseases; therefore, strong consideration should be given to traditional immunosuppressive regimens because of the relatively high cost of IFN-alpha and its potential of exacerbating autoimmunity |
associated skin disease:
| o | Necrolytic acral erythema (other “necrolyitic erythemas” = necrolytic migratory erythema, acrodermatitis enteropathica, pellagra, essential fatty acid/biotin deficiency) |
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